血清hs-CRP、sICAM-1在慢性心力衰竭患者中的变化及与近期预后的相关性

Changes of serum hs-CRP and sICAM-1 in patients with chronic heart failure and their correlation with short-term prognosis

目的分析血清高敏C反应蛋白(hs-CRP)、可溶性细胞间粘附分子1(sICAM-1)在慢性心力衰竭(CHF)患者中的变化及与近期预后的相关性。方法选取2017年1月-2020年6月收治的CHF患者98例,作为CHF组。另选取性别、年龄相匹配的健康志愿者100例,为对照组。检测并对比两组的血清hs-CRP、sICAM-1水平。CHF患者出院后随访6个月,统计两组的主要心脏不良事件(MACE)发生情况,根据是否发生MACE将其分为预后良好组与预后不良组。对比预后良好组与预后不良组的血清hs-CRP、sICAM-1水平及其他病理特征。多因素Logistic回归分析hs-CRP、sICAM-1是否为影响CHF患者近期预后不良的危险因素;绘制受试者工作特征曲线(ROC)评价hsCRP、sICAM-1对CHF近期预后不良的预测价值。结果与对照组比较,CHF组血清hs-CRP、sICAM-1水平更高(P<0.001)。预后不良组年龄、血清hs-CRP、sICAM-1、左心室舒张末期内径(LVEDd)高于预后良好组、LVEF低于预后良好组(P<0.05)。Logistic回归分析显示血清hs-CRP、sICAM-1及LVEDd是影响CHF近期预后不良的独立危险因素(OR=2.447、2.683、2.130,P<0.05)。ROC显示血清hs-CRP联合sICAM-1预测CHF近期预后不良的灵敏性、特异性、约登指数、曲线下面积(AUC)分别为66.70%、84.60%、0.512、0.805(95%CI:0.706-0.878),联合预测的特异性、约登指数、AUC均大于血清hs-CRP、sICAM-1单独预测。结论CHF患者存在血清hs-CRP、sICAM-1异常升高,且清hs-CRP、sICAM-1是影响CHF患者近期预后不良的独立危险因素,二者联合对于预测CHF近期预后不良有较高的临床价值。

Objective To analyze the changes of serum high-sensitivity C-reactive protein(hs-CRP)and soluble intercellular adhesion molecule 1(sICAM-1)in patients with chronic heart failure(CHF)and their correlation with shortterm prognosis.Methods 98 CHF patients admitted from January 2017 to June 2020 were selected as the CHF group.In addition,100 healthy volunteers with matching gender and age were selected as the control group.The serum levels of hs CRP and sICAM-1 were detected and compared between the two groups.CHF patients were followed up for 6 months after they were discharged from the hospital.The occurrence of major adverse cardiac events(MACE)in the two groups was counted.According to whether MACE occurred,they were divided into a good prognosis group and a poor prognosis group.The serum hs-CRP,sICAM-1 levels and other pathological characteristics of the good prognosis group and the poor prognosis group were compared.Multivariate Logistic regression analysis whether hs-CRP and sICAM-1 are risk factors that affect the short-term prognosis of CHF patients.Draw receiver operating characteristic curve(ROC)to evaluate the predictive value of hs-CRP and sICAM-1 for the poor prognosis of CHF in the near future.Results Compared with the control group,the serum hs-CRP and sICAM-1 levels in the CHF group were higher(P<0.001).The age,serum hs-CRP,sICAM-1,left ventricular end diastolic diameter(LVEDd)in the poor prognosis group were higher than those in the good prognosis group,and LVEF was lower than the good prognosis group(P<0.05).Logistic regression analysis showed that serum hs-CRP,sICAM-1 and LVEdd were independent risk factors affecting the short-term poor prognosis of CHF(OR=2.447,2.683,2.130,P<0.05).ROC showed that the sensitivity,specificity,Youden index,and area under the curve(AUC)of serum hs-CRP combined with sICAM-1 in predicting poor shortterm prognosis of CHF were 66.70%,84.60%,0.512,0.805(95%CI:0.706-0.878),the specificity,Youden index,and AUC of the combined prediction were greater than those predicted by serum hs-CRP and sICAM-1 alone.Conclusion Serum hs CRP and sICAM-1 in CHF patients are abnormally elevated,and qinghs CRP and sICAM-1 are independent risk factors influencing the prognosis of CHF patients in the near future.The combination of the two factors has a high clinical value in predicting the prognosis of CHF in the near future.